Growth in the Care of Older Patients by Hospitalists in the United States.
Growth in the Care of Older Patients by Hospitalists in the United States.
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DOI：
10.1056/nejmsa0802381
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发表时间：
2009-03-12
影响因子：
158.5
通讯作者：
Goodwin, James S.
中科院分区：
文献类型：
--
作者：
Kuo, Yong-Fang;Sharma, Gulshan;Goodwin, James S.
背景：缺乏关于美国住院医生对患者护理增加的全国性和基于人群的信息。方法：使用 1995 年、1997 年、1999 年以及 2001 年至 2006 年期间 5% 的 Medicare 受益人样本，我们确定了 5800 家美国医院中为老年患者提供护理的 120,226 名普通内科医生。我们将住院医师定义为普通内科医生，他们 90% 或以上的医疗保险评估和管理服务索赔来自住院患者的护理。然后，我们计算了住院医师提供的所有住院医疗保险服务的百分比，并确定了与接受住院医师服务相关的患者和医院特征。结果：普通内科医师中被认定为住院医师的比例从 1995 年的 5.9% 增加到 2006 年的 19.0%，普通内科医生提出的所有住院评估和管理服务索赔中归因于住院医师的百分比从 9.1% 增加到 同期为 37.1%。随着住院医师护理的增加，所有住院 Medicare 患者中接受普通内科医生（住院医师和传统的非医院普通内科医生）治疗的比例也有所增加，从 1995 年的 46.4% 增加到 2006 年的 61.0%。在控制患者和医院特征的多层次、多变量分析中，接受住院医师护理的几率每年增加 29.2%从 1997 年到 2006 年。2006 年， 住院医生提供的护理率存在明显的地理差异，在一些医院转诊地区，这一比例超过 70%。结论：对 Medicare 索赔数据的分析显示，从 1995 年到 2006 年，住院医生对住院患者的护理大幅增加。N Engl J Med 2009;360:1102-12。
Background: National and population-based information on the increase in patient care by hospitalists in the United States is lacking.Methods: Using a 5% sample of Medicare beneficiaries in 1995, 1997, 1999, and the period from 2001 through 2006, we identified 120,226 physicians in general internal medicine who were providing care to older patients in 5800 U.S. hospitals. We defined hospitalists as general internists who derived 90% or more of their Medicare claims for evaluation-and-management services from the care of hospitalized patients. We then calculated the percentage of all inpatient Medicare services provided by hospitalists and identified patient and hospital characteristics associated with the receipt of hospitalist services.Results: The percentage of physicians in general internal medicine who were identified as hospitalists increased from 5.9% in 1995 to 19.0% in 2006, and the percentage of all claims for inpatient evaluation-and-management services by general internists that were attributed to hospitalists increased from 9.1% to 37.1% during this same period. Accompanying the increase in care by hospitalists was an increase in the percentage of all hospitalized Medicare patients who were treated by general internists (both hospitalists and traditional, non-hospital-based general internists), from 46.4% in 1995 to 61.0% in 2006. In a multilevel, multivariable analysis controlling for patient and hospital characteristics, the odds of receiving care from a hospitalist increased by 29.2% per year from 1997 through 2006. In 2006, there was marked geographic variation in the rates of care provided by hospitalists, with rates of more than 70% in some hospital-referral regions.Conclusions: These analyses of data from Medicare claims showed a substantial increase in the care of hospitalized patients by hospitalist physicians from 1995 to 2006.N Engl J Med 2009;360:1102-12.